Pharmacology review

Study Guide for NLN RN Pharmacology Exam Drug Acetylsalicylic acid(Aspirin) Antiplatelets Non opeoid analgesic Increase coagulations studies Decrease serum K Activated charcoal (Actidose-Aqua) Given 1gm/kg of body weight Pre mixed with water 12.5-25 grams Charcoal does not change the stomach PH Use and dosage Blocks pain impulse in CNS, antipyretic result from vasodilatation of peripheral vessels, inhibit platelets aggregation Treat TIA, Post MI, Stroke, angina Side effect Increase PT, PTT Reye’s syndrome (encephalopathy and fatty liver), GI bleed, tinnitus, liver toxicity(dark urine, clay stool, itching, yellowing sclera and skin), visual changes Treat poison and overdose following oral ingestion It binds to poison and prevent its absorption by the GI tract and it eliminate in the feces Charcoal must be administered within 60 minutes of ingestion Ipecac-induce emesis of stomach pups is also used Charcoal may be given once or twice depending on the level of toxic Incorrect application say into the lungs, results in pulmonary aspiration which can be fatal Teaching and labs Take with full glass of water, milk for food to prevent stomach upset Do not crush enteric coated, given 30 prior to or hrs after meals Therapeutic in weeks, not give children with flu-like symptoms or chickenpox symptoms (Reye syndrome) Binding is irreversible so cathartic such as sorbitol may be added as well It interrupts enterohepatic circulation of some drugs/toxins and their metabolites It allows certain drugs/toxins to be drawn out of the blood and bind to charcoal in the intestine a kind of ― gut dialysis‖ contraindication Do not give children under 12 because of risk of Reye syndrome, children or teenagers with chicken pos or flu like symptoms, pregnancy in 3rd trimester, and decrease effect of ASA with antacid, vit K deficiency In ingestion substance that is acid an alkali or a petroleum product Do not gastric lavage on pt who swallow caustic agent, convulsions are occurring, high viscosity petroleum products have been ingested, cardiac dysrhythmias are present, or there is emesis of blood Antidote supportive care and preventing aspiration are Page of 64 Study Guide for NLN RN Pharmacology Exam Alteplase recombinant (Activase) Thrombolytic Streptokinase, urokinase given mostly in emergency situation Dissolve or break down clots to reestablish perfusion Is indicated for clients at risk for developing thrombus with resultant ischemia such as MI, ischemic stroke, arterial thrombosis, DVT, pulmonary embolism an occlusion of catheter shunts Hemorrhage, N/V, hypotension cardiac dysrhythmias Dose related is the highest problem Aluminum hydroxide (Amphogel) is Antacid Neutralize gastric acid, antflatulent to alleviate symptoms of gas and bloating Antacid increase gastric pH, decrease absorption of other drugs such as dig, antibiotic, iron supplement Belching, constipation, flatulence, diarrhea gastric distention Acid rebound if given too often Toxicity cause dementia, Give Amicor for overdose Given also for excessive bleeding From cardiac surgery, trauma abruption placenta thrombolytic agent antidote Monitor VS changes, watch for signs of impending shock ( ) If bleeding is occurring stop treatment and notify doctor Start on FFP and PRBC Do not take NSAID and Aspirin because of enhanced bleeding Given hrs apart from other drugs where drug interaction may occur Observe for signs and symptoms of altered phosphate levels; anorexia, muscle weakness and malaise Increase fluid, exercise and fiber to prevent constipation implemented if gastric lavage is not to be performed Do not give during pregnancy, actively bleeding, recent Hx of CVA, Uncontrolled HTN, IM rout is contraindication when using thrombolytics In the presence of abd pain, N/V, diarrhea, severe renal dysfunction, fecal impaction, rectal bleeding, colostomy, illeostomy Severe renal disease, dehydration hypercalcemia andhypercalciuria Page of 64 Study Guide for NLN RN Pharmacology Exam Ampicillin (Ampicin) IV, PO, IM Treat bacterial infection Shigella, salmonella, Escherichia coli, haemophilus influenza, neisseria gonorrhea, neisseria meningitis, gram positive organism Atropine Sulfate (antichologenic) for Parkinson Treat parkinson’s disease, use to increase heart rate Hypercalcemia, metabolic alkalosis, worsen HTN, heart failure from increase intake Most common allergic reaction: Skin rash urticaria, purities, angioderma Purities rash like measles is not a true allergic reaction but develops 7-10 days of therapy and may last for a few days after therapy Most common side effects: GI, N/V, diarrhea epigastric distress abd pain colitis elevated liver enzymes, taste alteration, sore mouth dark/discolored/sore tongue Toxicity: treat type toxicity within 230 minutes it is fatal, N/V, urticaria, purities severed dyspnea, stridor, tachycardia, hypotension, red scaly skin Dry mouth, constipation, urinary retention or hesitancy Do not give with fruit juice, milk or carbonated beverages because of poor absorption, monitor renal studies, liver enzymes and electrolyte due to hypokalemia Take on empty stomach May not necessary to stop treatment if mild diarrhea develops Give yogurt or buttermilk to restore normal flora Use absorbent antidarrheal agent Not use in pt with exfoliated dermatitis, Loop diuretic may exacerbate hypokalemia and rash K sparing diuretic may contribute to hyperkalemia Monitor dosage of meds carefully, even slight overdose can lead to Increase antichologeneric effect with phenothiazine, Page of 64 Study Guide for NLN RN Pharmacology Exam For ophthalmic use It decreases involuntary movement and rigidity in parkinsonism Use for inflammation of the iris and uveal tract headache,dixxiness Adverse effect/toxicity Paralytic ileus Assess mental status, Adverse effect when used for the eye Transient stinging, dry mouth, N/V, dry skin, bradycardia, slurred speech, weakness drowsiness, palpitation, tachy, increase IOP, photophonia, urinary hesitancy, heart prostration, decrease sweating toxicity Assess for constipation; increase fluids, bulk and exercise, assess bowel sound to rule out paralytic ileus, watch for urinary retention, avoid driving or other hazardous activities, drowsiness may occur For the Eye Acute glaucoma can be precipitated by papillary dilation; if not recognized and treat, acute glaucoma can result in blindness Wear dark sunglass and avoid bright light for photophobia, Monitor intraocular pressure and vision should be monitored over the course of the therapy antidepressant, MAO’s amantidine Contraindicated in pt with narrow angle glaucoma, myasthenia gravis, or GI obstruction should not use Used in bronchial asthma, allergic rhinitis SE: Pharyngeal irritation and sore throat, coughing, dry mouth, oral fungal infections, and sinusitis Adverse effect/toxicity Decrease dose if pt is on systematic corticosteroid., assess for impaired bone growth in children receiving inhaled corticosteroid In children under Clients with known allergy may adjust dose of antidiabetic agent secondary to potential for elevated blood Systemmatic effect is more pronounced in infant and children with blue eyes and blond hair Beclomethasone diproprionate (Beclovent) ) inhaled corticosteroid medication Page of 64 Study Guide for NLN RN Pharmacology Exam Adrenocortical insufficiency fluid and electrolyte disturbances, nervous system effects and endocrine effects if absorbed systemically Increase susceptible to infection, dermatologic effects and osteoporosis, diarrhea, N/V, HA, fever, dizziness angioedema rash urticaria and paradoxical bronchospasm, Benztropine mesylate (Cogentin) – Treat Parkinson disease Hypersalivation and SE: dry mouth, urinary retention/hesitancy, HA, glucose levels with corticosteroids are administered orally No\t use in bronchospasm or status asthmaticus Considerations: monitor for huperglycemia,, ask if pt is taking current medication including OTC and history of allergies Rinse mouth after use for medication because ofopharyngeal candiadiasis and or hoarseness can occur Education: inhale bronchodilator drug before corticosteroid when both are ordered Wait prescribe interval between puffs and rinse mouth after use of inhalation device Do not abruptly stop meds taper over weeks Be aware of steroids symptomsMoon face, acne increased fat, pads increase edema; notify doctor Report weight gain more than pounds in a week Nurse, Monitor dose Clients with narrowcarefully; angle glaucoma, Page of 64 Study Guide for NLN RN Pharmacology Exam Anticholinergics Treat Parkinson and Extra pyramidal syndrome EPS irregular movement related to Parkinson disease dizziness Adverse effect /toxicity paralytic ileus Chloradiazepoxide hydrochloride (Librium) CNS agent, sedation-IM & tablet form class: Benzodiazepine sedative-hypnotic Capsules: mg, 10 mg, 25 mg, Injection: 100mg ampules To relieve tension, anxiety, and to manage alcohol withdrawal Adverse effect: respiratory distress, drousy, dizziness, lethargy, Peak 1-4 hours po, 15-30 IM Half life 5-30hr Nurse Monitor CBC and hepatic enzyme levels in prolonged therapy • Monitor renal and hepatic studies • Assess patient for apnea, bradycardia, and hypotension Suicidal tendencies may be present and protective measures may be necessary even slight overdose can led to toxicity Nursing considerations: I&O’s, protect pt form heatlh Education: Avoid driving, or other hazardous activities; drowsiness may occur Avoid cough OTC medication unless prescribed Use cautiously in pt with impending depression, impaired hepatic or renal function, copd Give with milk or food to prevent GI upset Nurse: check BP and pulse before initiation If bp falls 20 mmHg delay medication and notify dr Education: avoid alcohol, no OTC unless prescribe, observe for dependency, avoid excessive sunlight No breastfeed myasthenia gravis, or GI obstruction should not use Narrow antgle glaucoma, under 12 year old LABS CBC, Na, K, hepatic enzyme levels in prolonged Page of 64 Study Guide for NLN RN Pharmacology Exam therapy renal and hepatic studies Assess patient for apnea, bradycardia, hypotension Teach: avoid driving and other hazardous activities until he knows how drug affects concentration and alertness avoid alcohol during therapy donot to stop taking drug abruptly Chloramphenicol (Chloromycetin) anti bacterial, anntfungal and antiviral agent for the eye Eye infection for susceptible organisms when less dangerous anti-infective are ineffective Sty, conjunctivitis, uveitis Adverse effect/toxicity Bone marrow hyperplasia, irritation, burning, itching angioeurotic edema super infection, aplastic anemia Steven-Johnson syndrome, SE: dermatitis, itching, stinging, swelling Chlorothiazide (Diuril) Thiazide diuretic, non Increase urinary excretion sodium and SE: Dizziness, vertigo, HA, weakness, N/V, and Nurse: obtain culture hypersensivitity specimen from eye before initiation of treatment, and remove exudates Monitor for pain, drainage, redness, selling Monitor for bleeding or bruising with chlormaphenicol Teaching: tell nurse of photosensitivity, redness swelling, increase drainage, pain or swelling if no improvement in a few days Consideration: take early Client with anuria Use in the morning to avoid cautiously in pt with Page of 64 Study Guide for NLN RN Pharmacology Exam K spearing water by inhibiting sodium reabsorption Use for HTN and kidney, Inhibit sodium reabsorption in the cortical diluting tubule of kidney, increase urinary excretion, for edema and HTN, CHF, cirrhosis, corticosteroid and estrogen therapy, diabetes insipidus, reduction of osteoporosis pain diarrhea, constipation, frequent urination, electrolyte imbalance, impared glucose tolerance, jaundice, muscle cramps, photosensivitity, impotence hyperuricemia Adverse/toxicity Renal failure, aplastic anemia, agranulocytosis, thrombocytopenia and anaphalytic reaction nocturia Given with food, allow for two weeks for maximum effect, will not be effective if creatinin clearance Is less than 30ml/min May alter serum electrolyte especially lowering potassium, increase serum urate, glucose, cholesterol triglycerides BUN and createrinin impared renal or hepatic function Do not use if pregnant Will increase serium lithium level Nurse: monitor vs, I&O, assess for dehydration; thirst poor skin tugor coated tongue monitor electrolyte levels Chlorpromazine hydrochloride (Thorazine) A phenothiazine Antipsychotic medication, Neurologic drug Typical antipsychotic meds to treat positive symptoms but is low potency and can reduce the risk of EPSE Block dopamine receptor in CNS to treat + symptom respond to typical antipsychotic drug, Use for intractable hiccups, treat psychotic disorder (schitzophrenia, bipolar, and other mental illness It suppresses acute episode, prevent acute exacerbation and maintain highest possible level of Adverse/toxicity Sedation, orthostatic hypotension, antichologenic effect(dry mouth, blurred vision, urinary retention, photophobia, constipation, tachycardia) akathisia , liver damage, tremor are two major side effects (uncontrollable need to move) & Parkinsonism (set of Teach: take early in day to avoid nocturia, take with food or milk, it takes 2-4 wks for antihypertensive effect Eat high K food, restrict socium intake, not use salt substitutes if taking K supplement, change position slowly to avoid dizziness and orthostatic hypotension weigh daily check blood glucose periodically if In pt with narrow angle glaucoma, adynamic ileus prostatic hyperplasia cardiovascular disease, hepatic or renal dysfunction and seizure disorder Drug interaction: may increase for agranulocytosis (low wbc) Page of 64 Study Guide for NLN RN Pharmacology Exam function Cimetidine hydrochloride (Tagamet) GI meds, H2 antagonist Work against histamine, decrease gastric mucosa Use short term for duodenal ulcer of benign gastric ulcer, acute upper GI bleed in critically ill clients GERD, heart burn and indigestion Cisplatin (Platinol) Half life 20-30 minutesAntineoplastic Treat ovarian and testicular cancer by interfering with DNA symptoms that resembles Parkinson’s disease), photosensivity occurs, clients should take measures to protect eyes exposed to sunlingt, Neuroleptic malignant syndrome (NMS), catatonia, rigidity, stupor, unstable blood prossure profuse sweating, dyspnia It sometimes occurs as Toxic effect and MAY last for 5-10 days after discontinuation of the med Cardiac dysrhythmia, diarrhea, dry mouth, constipation Adverse/Toxicity Rare but may include agranulocytosis neutropnia , thrombocytopenia aplastic anemia, anaphylaxis Major toxicities occur in the Hematopoietic, gastrointestinal and diabetic Nurse: get baseline ECG, thorough baseline evaluation lab tests befor treatment Give bromocripitine (parlodel) and dantolene (dentroim) for NMS Withdrawal of drug is necessary May be given with meals and at bedtime Nurse reduce dose in pt with hepatic or renal impairment Teach: avoid smoking which cause gastric stimulation, avoid antiacid it reduces acidity so use hour of dose Nurse hydrate with oral or iv fluids before and after administration, Hypersensivity to drugs Use caution in clients with impared renal or hepatic function, may increase salicylate leavels with high doses of aspirin, may increase coumadin effect Hx of sensivitity to platinum-contaning compounds, impared Page of 64 Study Guide for NLN RN Pharmacology Exam medication, Alkylating agent Major allergic reaction can occur withing first 15 mins of administration Monitor closely for Signs of anaphylaxis during the first 15 of infusion Monitor for decrease Na, K, Ca, mag replication SE/Toxicity Renal and hepatic toxicity, myelosuppression, peripherial neuropathy; neurotoxicity, metallic taste N/V Codeine sulfate Opioids analgesic (agonist) to block opeoid receptors through CNS Rapid onset if IM or IV Peak 1-2 hrs, duration up to To treat moderate pain most oral preparations combined with ASA or acetaminophen reproductive system Nurse Monitor Urine output and urine specific gravity for consecutive hours before therapy initiation and for 24 hour After; report urine < 75 cc/hr it require medical attention Anaphylactic may occur within minutes of drug initiation Assess BUN serum uric acid, creatinin, creatinin clearance Nephrotoxicity occur within wks of therapy Suspect ototoxicity if client manifest tinnitus or difficulty hearing in the high frequency range given PO on empty stomach; if N/V are severe it may be taken with food; anti-emetic agent should be given before the drug is administered and on a schedule basis throughout the day and night Avoid food high in thiamin(beer, wine cheese, brewer’s yeast, chicken liver & banana) may lead to hypertension & intracranial hemorrhage TEACH maintain oral fluid at least 3000 in 24 hr report reduce UO, anorexia, N/V uncontrolled by antiemetic, fluid retention and weight gain N/V, anorexia, loss of Nurse check for appetite sedation, sensivity prior to constipation, GI cramps administration, assess urinary retention, oligura, pain,assess respiration purities light headedness and withhold if resp is < dizziness 12 breaths per minute, assess CNS Adverse/Toxicity renal function and hearing, Hx of gout, urate renal stones Incompatible with dextrose and raglan, vancomycin, lasix may increase otoxicity Incompatible with other nephrotoxicity drugs, may increase nephrotoxicity and renal failure Do not use if has acute bronchial asthma or upper airway obstruction, ICP, convulsive disorders, pancreatitis, acute ulcerative colitis or Page 10 of 64 Study Guide for NLN RN Pharmacology Exam the body can absorbed, Warfarin sodium (Coumadin) anticoagulant Given PO Has narrow therapeutic range Therapeutic effect will be seen in one week PT llevel will maintain at 1.5 – 2.5 the times the control value INR range from, 2.0- 3.0 Onset of action is slow coumadin is titrated to keep INR 23 coumadin resemble vit K and interfere with synthesis of clotting factor that require vit K several clotting factors 11, vii, ix and x are also reduced thereby prolog clotting cascade Teach duration of therapy may be several months to lifelong S/E Ecchymotic skin, GI & skin problem Hypotension, thrombocytopenia Adverse/toxic Bleeding is the major adverse effect Nausea, diarrhea, intestinal obstruction, anorexia, abd cramping, rash urticaria, purple toe syndrome(discoloration caused by decreased perfusion for release of microemboolic peanut, corn, olive or soybean should be avoided or use sparingly during coumadin therapy LAB PT INR May be given in the evening and lab draws in the morning Nurse Monitor PT, INR Teach length of therapy, close follow up monitoring if adverse effect or toxicity, withhold coumadin and give Phytonadione (Vit K) TEACH teach about bleeding problem and how to respond Use soft toothbrush and electric raiser to minimize trauma that could lead to bleeding Observe for bleeding gums, bruises, nosebleed, tarry stools, hematuria, hematemesis and petechiae, report these finding to the prescribe avoid food high in Increase reaction may be seen in pt on garlic but there is increase risk with garlic, ginger gingko biloba, cayenne Green tea, ginseng an goldenseal decrease effectiveness of coumadin Page 50 of 64 Study Guide for NLN RN Pharmacology Exam vitamin K Zovirax Antiviral, Antiinfective Sucralfate (Carafate) Mucosal protective agent Treatment of recurrent and initial mucosal and cutaneous herpes simplex Also use orally in varicella zoster (chicken pox) Does not eradicate latent herpes It reduces viral shedding and formation of new lesions and speeds healin time Protects the site of ulcer from gastric acid by forming an adherent coating with albumin and fibrinogen; it absorbs pepsin decreasing its activity It is use short term for duodenal ulcers with continued maintenance treatment at low doses; investigational use for gastric ulcer Also use in esophageal ulcer related to radiation or chemotherapy, HA, dizziness, seizure, nausea vomiting diarrhea acute renal failure thrombocytopenia purpura hemolytic uremia syndrome Even aftrer HSV infection is controlled, latent virus can be activated bty stress, trauma, fever exposure to sunlight, sexual intercourse Refrain form sex if S/S of herpes Dizziness, headache, constipation, diarrhea, nausea, vomiting flatulence, dry mouth and rash, may cause apotting cramping dysmenorrheal, menstrual disorders and postmenopausal bleeding Adverse/toxicity Angioedema, resp difficulty, loaryngospasm, seizure NURSE Taken hour before meal and bedtime or hours after meals Take hours after medication and not within hours of antacid Assess for pregnancy TEACH Avoid gastric irritants such as caffeine, alcohol, smoking and spicy foods Report immediately if there is any difficulty breathing or swallowing In patient who are allergic to prostaglandins or whjo are pregnant May cause miscarriage Page 51 of 64 Study Guide for NLN RN Pharmacology Exam Drug classifications: Aminoglycoside antibiotics Class of antibodies including gentamcin and tobamycin some of which are derived from microorganisms while others are produced synthetically It is to treat serious life threatening gram negative infetion All aminoglycodside ends Mycin but not all drugs that ends in Mycin are aminoglycosides such as (Erythromycin and zetromycin) IM or IV Molnitor Peak and Traugh 30 before dose Oral route is not recommended It is poorly absorbed It is only use for bowel prep prior to surgery to eliminate bacteria or to prevent absorption of ammonia in hepatic encephalopathy Secondary infection may cause because of the damage to normal floral Candidiasis ( skin and mucous membrane caused by Candida albicans Thrush, occurs on mucous memberanes of oropharynx bronchi, vagina and anus White plaque; red, scaley, popular skin rash can occur in warm moist dark areas such as Bleeding may occur with oral antibiotic because amino glycoside decrease vit K synthesis in the intestine Other SE; headache, paesthesia, skin rash, fever Adverse/Toxicity Two most common adverse effect.Nephrotoxicity; and ototoxicity; Nephrotoxicity; hypotension, dehydration, preexisting renal disease and coadministration of other nephrotoxic drug Oto Class of antibodies including gentamcin and tobamycin some of which are derived from microorganisms while others are produced synthetically Ototoxicity may not be reversible; dizziness, BUN CREAT to monitor Preexisting renal renal function Bun to disease, concurrent Creat ratio 20-1 or 15-1 order ror renal toxic agent If creatinin elevated within 3-4 days of treatment It means renal damage has occurred OTHER ADVERSE Effect Pseudomembranous colitis; Secondary infection of bowel usually caused by clostridium difficle May be seen 4-6 weeks; watery stool/day with blood/mucous, abdominal pain and fever Discontinue ATB and vancomycin is given PO or Flagyl Page 52 of 64 Study Guide for NLN RN Pharmacology Exam in breast folds, axilla, groin light headedness, tinnitus hearing loss Ototoxicity, Kidney toxicity(nephrotoxic), kidney toxicity Photosensitivity is common to both classes of antibiotics that it Aminoglycosides and Sulfonamides Treat gram negative Rash common; most are Nurse take adequate In polyurea advance Sulfonamides: bacteria It inhibit folic urticaria and amount to fluid 3renal or hepatic Antiinfectives Bacteriostatic which acid synthesis to prevent maculopapular Nausea, 4000ml/day to promote dysfunction or with action on bacteria results cell growth Treat UTI, vomiting diarrhea, abd urinary output at least intestinal and urinary from interference with Chlamydia causing pain, jaundice, stomatitis, 1500ml/d to prevent blockage, asthma It the functioning of blindness, pneumonia, HA, insomnia, crystalluria/stone increase risk for enzyme systems brain abscess, ulcerative drowsiness, depression, formation, if not bleeding with oral necessary for normal colitis, active Crohn’s psychosis, possible, may give anticoagulant and metabolism, growth and disease, rheumatoid photosensitivity, antacid or sodium bicarb increase blood glucose multiplication arthritis, nocardosis crystalluria to alkalinize urine with oral antidiabetic Given every hours Alkaline ash diet may be drugs CAUTION: not use Adverse/Toxicity peripheral helpful with include fruit LABS Bun, Creat, in patients with known neuritis/neuropathy, vegetables and milk urinalysis to monitor allergies to sulfa drugs tinnitus, hearing loss, renal function, AST, except Plums, prunes vertigo, ataxia, ALT to monitor liver cranberries convulsion, hepatitis, May be taken after meals function, CBC to Antibiotic ends with pancreatitis anemia, to prolong time in monitor blood Mycin, agranulocytosis, intestine, Collect C&S dyscrasias and response Micin, and others: thrombocytopenia, prior to beginning to therapy leucopenia, eosinophilia, therapy provide hypothrombinemia hydration, give small Steve Johnson syndrome( frequent meals with high an adverse reaction of quality proteins; drugs skin that resembles that may be taken with appearance of partial food may decrease GI Page 53 of 64 Study Guide for NLN RN Pharmacology Exam Thiazide diuretics: (Hydroduril, hydrochlorothiazide (Diuril) non-K sparing diuretic Has hypotensive effect dilate the vessels and decrease peripheral resistance Name ends in ZIDE Tricyclic Antidepressants Initial mechanism of TCA takes 1-3 weeks to develop Maximum response is achieved in Act on distal tube inhibit NA-Cl symport leading to a retention of water in the urine and water commonly follows penetrating solutes Use for edema a hypertension BP above 140/90 Block the reuptake of norepinephrine or serotonins or both, leaving more available in the CNS It intensify the effect of nor epinephrine and thickness burns Dizziness, vertigo, HA, weakness, dehydration, orthostatic hypotension, nausea vomit, abd pain, diarrhea, constipation, frequent urination, dermatitis and rash Electrolyte imbalance impaired glucose tolerance, jaundice, muscle cramps photosensivitity impotence and hyperuricemia Adverse/toxicity Renal failure, aplastic anemia, agranuloctyosis, thrombocytopenia, anaphylactic reaction upset Take early in the day to avoid nocturia and early afternoon to prevent nighttime interruption Take with food or mild to avoid GI upset Thiazide is ineffective if creatinin clearance is < 30ml/min TEACH will see effect of hypertensive within 14 wks Eat foods high in potassium, restrict sodium, not use salt substitute if taking potassium supplement, change position slowly to avoid dizziness and orthostatic hypotension, weigh self daily report sudden weight gains or losses The most undesirable effect of TCA are orthostatic hypotension, sedation and anticholinergic effects.Urinary retention, overdose may cause Nurse Taken at nights, it causes sedation Do not take with MAO it will cause hypertensive crisis from excessive adrenergic stimulation of the heart and blood No Metolazone for children In clients with anuria LABS may lower potassium may increase urate glucose, cholesterol triglycerides, BUN and Creatinin Use with caution in pt with Glaucoma, elderly, constipation, prostatic hyperplasia, as they are more sensitive to antichologenic effect Contraindications in Page 54 of 64 Study Guide for NLN RN Pharmacology Exam 6-8 wks Has long half life Tricyclics ends in INE Some meds Pamilor, anafranil, elavil, sinequan tofranil Pam, Anna, and Elavil Sin, To serotonin which can elevate moodk increase activity and alertness, decrease preoccupation with morbidity, improve appetite and regulate sleep pattern It is use to treat insomnia, attention deficit/hyperactivity and panic disorder convulsion Adverse/toxicity Most serious adverse effect is cardiac toxicity; in the absence of overdose or preexisting cardiac impairment, serious cardiotoxicity is rare To avoid adverse cardiac effect, pt over 40 and those with heart disease should have baseline ECG and every mths URINARY RETENTION IS URGENT vessels, monitor orthostatic BP of pt in hospital TEACH; move slowly when changing position, Advise early of the potential SE and that therapeutic response will take some weeks tobe established, treatment may go up to 6-12 mths If there is no change in 2-4 wks may think about changing the meds hypersensitivity, MI, Cardiovascular disease Cleans exudates from eye, tilt head toward side of affected eye, pull lower eyelid down, have pt look up instill drops in sac formed by lower lid (not onto the eye), Apply gentle pressure for 30 sec to over inner cantus next to nose this prevents absorption through the tear duct and drainage of the medication Close eyes gently massage the eyes To distribute the EYE OINTMENT Same as eye drop except medication it is express directly into the conjunctival sac from the inner canthus to the outer canthus, close eyes and gently massage Administration routes: Sublingual administration Eye drop administration Page 55 of 64 Study Guide for NLN RN Pharmacology Exam Intramuscular injections Given in the vasuts lateralis in children up to Blood administration Start blood transfusion slow ml/min Remain with pt for the first 1530 if there is no sign of side effect, increase rate to the desired rate Oral administration Absorbed directly into the bloodstream to distribute the meds Spread skin taught to bring muscle near surface of skin, with dartlike motion insert needle at 90 degrees Place tablet on floor of mouth, close mouth Do not swallow, hold under tongue until dissolve Observe for acute reaction such as; allergic, febrile, septic, hemolytic, air embolism, circulatory overload by assessing VS, breath sounds, edema, flushing, urticaria, vomiting, headache back pain Use spray on floor of mouth under tongue and close mouth Buccal place tablet between gum and cheek near back of mouth, close mouth and keep in place until dissolve A response to a drug that is the opposite to the Pills or capsule Usual response such as agitation produced in an individual patient by a They can often be taken Aspirate to determine if needle enter a vessel If there is blood return discard the needle and meds and start procedure over Observe for delayed reaction Graft VS host (hemolytic, iron overload, hepatitis, Definitions: Paradoxical reaction Sustained release/time Drug Medical treatment Effect an effect , usually a drug, has an normally expected opposite Contain in a matrix of so that the drug has first Page 56 of 64 Study Guide for NLN RN Pharmacology Exam released/extended release/controlled release/continuous re Osmotic agent (Mannitol and glucose) Use in oliguria and acute renal failure Help to prevent renal failure and reduce increased intracranial or intraocular pressure formulated to dissolve slowly and release drug overtime Filtration of large amount of substance which cannot be absorbed by the nephron ONSET 15 PEAK 0.5-2 hours DURATION 3-10 hrs Half life 15 – 100 minutes less frequently, keep steadier levels of the drug in the bloodstream It inhibit sodium reabsorption in proximal tubule, descending limb (due to rupture of blood vessels within richly perfuse nasal mucosa spontaneous or initiated by trauma Nose bleed Can be anterior or posterior Posterior is more serious ADVERSE REACTION It expand plasma volume resulting in circulatory Overload and tachycardia Electrolyte imbalance, cellular dehydration, extravasations at injection site, rebound ICP 8-12 hrs after diuresis and angina like CP, blurred vision, thirst, urine retention, symptoms blood can come up through the eye, can also flow down the stomach causing nausea, vomiting Agranulocytosis/ Acute decrease in the Drugs and chemicals or Diuresis occur in 1-3 hrs Epistaxis insoluble substance (eg Acrylics) the drug swells up to form Gel (eg Mannitol) there is increase excretion of water and sodium to dissolve in matrix then exit through the outer surface It acts by increasing the osmolality of plasma, glomerular filtrate, and tubular fluid This Nurse use IV filter set, decrease the Monitor I&O Therapy reabsorption of fluid and is based on urine flow electrolytes, which rate increase excretion of Reassure pt that water, chloride and excessive thirst, blurred sodium and slightly vision, rhinitis should increase the excretion of subside when mannitol is Potassium discontinued Treat cauterization with silver nitrate, calcium alginate mesh, nasal cavity packed with sterile dressing ribbon gauze, absorbent dressing or saline sprayed into the nose, Lymphadenopathy, Ice pack to forehead or back of the neck, pinch septal of nose for minutes Do not pack nose with tissue or gauze radiation Page 57 of 64 Study Guide for NLN RN Pharmacology Exam Neutropnea/agranulocyt opnea (treat with broad spectrum pcn, or cephalosporin(piperacilli n tazobactam, cetazidime, ticarcillin, gentgamycin, bone marrow transplant Half-life -The time it takes for a substance to lose half of its pharmacologic or physiologic activity or how long the drug takes to be metabolized and excreted by the body no of granulocytes/lukopnea (WBC) in peripheral blood is impaired resulting from bone marrow depression by replacement by a neoplasm(oral lesion, ulcer necrotic, gingivitis, buccal mucosa lmphadenitis are prevalent It is induce by drug such As sulfonamides, chemotherapy, Chelating agents A form of detoxification, chelating therapy involves an injection or oral administration of ethylene diamine Tetra acetic avide A synthetic amino acid atttaches to toxic substance such as lead, cadmium, aluminum and Use in children with led level between 45&70 micron/dl Ethylenediaminetetraace tic acid (EDTA) bind to lead in blood and excreted by the bowel and kidney EDTA may be toxic to kidney Monitor urine output Give this by IV Dose depends on weight of child, severity of the poison OTHER AGENTS British antiLewisite (BAL) does not give with iron supplement and avoid in pt with plant allergy Give this by IM Succimer (Chemer) Chemet Give PO Do not give in pt with encephalopathy Agent is give every hours for days A second course ma be needed if there is a rebound in the blood level Give oral and IV fluid to enhance excretion Leading to respiratory infection ulceration of mouth colon, high fever, UTI But may be asymptomatic Page 58 of 64 Study Guide for NLN RN Pharmacology Exam other metal in the blood to facilitate their removal from the body May be use to treat hardening of the arteries, heart attack, stroke, arthritis and gangrene because of its ability to remove excess calcium from the body Specific Diseases: Liver Disease Hep A cause by RNA virus of enterovirus family Trnsmit through fecal-oral through ingestion of food or liquids contaminated with the virus Spread to person by person and through contact, overcrowding, incubate 3-5 wks occurrence in children and young adult May have no symptoms Prodomal S/S fatique, anorexia, malaise, HA, low grade fever, nausea vomit Contagious during this Hep B HBcAG found only found in liver cell Transmitted through blood percutanous, permucosal routes Oral, breast feeding, sexual acativity semen, blood saliva, vaginal secretion It is the main cause of Cirrhosis symptom is insisious and prolonged that HAV May be asymptomatic wk -2 mths of Prodomal symptom; fatigue anorexia, transient fever, abd discomfort N/V, HA Hepatic S/S, myalgia, Hep D virus is a defective RNA and replicate only with Hep B it requires HBsAg to replicate Occur with HBV Cannot outlast a Hep B infection, may be acute or chronic Mode of transmission same as Hep B occurrence is mainly among IV drug users Multiple blood transfuse pt occur in Middle east, south Africa and Mediterranean S/S similar to HBV but more severe With superinfection of chronic Hep E Transmit through fecal-oral route It inconsistently shed in feces and it difficult to detect Incubation same as Hep A (3-5 wks) Occur in india, Africa, asia, central America, but may found in young adult and more severe in pregnant women Page 59 of 64 Study Guide for NLN RN Pharmacology Exam period usually wks before the onset of jaundice Symptom milder in children than adult HIV treatment Antiviral protease inhibitor Use prophylacatally Use in combination to decrease viralload and increase CD4 rapidly absorbe from GI tract Ends in AVIR Inhibit cell protein synthesis that interfere with viral replication; block protease activity in HIV Treat aids and aids related complx to decrease viral load M photophobia, arthritis, angioedema photophobia rash vasculitis, jaundice in Icteric phase Hep C occur through blood or blood product, IV drug users, sexual intercourse Incubation period 1wek to several months S/S similar to HBV but often less severe Symptoms occur 6-7 wks after transfusion Some Pt may develop chronic liver disease and some may progress to Cirrhosis HA, fatigue, nausea, vomiting, diarrhea, abd discomfort, anemia, taste perversion, asthenia, circumoral paresthesia with ritonivair, Adverse/toxicity Hepatoxicity, reduce dose in liver dysfunction TEACH Use neutorpenic precautions, eat small frequent meals with HBV, carriers cause sudden worsening of condition and rapid progression of cirrhosis Nurse monitor Hepatotoxicity AST, ALT, bilirubin; observe for nausea, vomiting jaundice upper right abd quad enlarge ement and tenderness Nephrotoxicity; creatinin, BUN, creatinine clearance, urinalysis, keep accuratre I& O monitor for SE of neutropenic, Not for pregnant or lactating woman Page 60 of 64 Study Guide for NLN RN Pharmacology Exam complete or complementary proteins Reverse transcriptase inhibitors: Stop replication/growth Reduces viral load One major advantage is that they not affect adversely affect development of blood cells Use in combination because resistant strains rapidly evolve if used as single agent therapy Ends in INE Diabetes treatment in children Hypoglycemic reaction took place most time before meals or when insulin effect is peaking First teaching is to tell parent to let child wear observe occult signs of infection (lower back, flank or suprapubic pain, normal temp or low grade fever related to UTI), Provide neutropenic care as appropriate Use for all symptomatic HIVpt with a CD4 coulnt less than 500mm3 AZT is used to prevent maternal transmission of HIV STOP if severe rsh or other hypersensietivity reaction occurs assess for opportunistic infection (cancer, neurological disese) Have same meal as normal child time intake of food Eat at the same time each day Children can start learn to assume responsibility for self management as soon as age 4-5 At age they can start giving Common meds: abacavir(ziagen) stavudine (Zerit, zidovudine (AZT) Exercise: not restrict exercise Have extra snack before and after exercise Exercise very regularly as it decreases the need for insulin Carry a source of glucose at all times ( hard candy, sugar cubes glucose tablets, insta glucose, the rapid releasing sugar is followed by complex CHO and protein such as slice bread or cracker After glucagons, vomiting may occur Place child on the side to prevent aspiration Preferred way of treating ketoacidosis is by insulin IV of low dosing Note Run a mixture of insulin Page 61 of 64 Study Guide for NLN RN Pharmacology Exam bracelet or tag Teaching to give injection Nurse use NS give parent injection and the parent the same with the nurse Inject at 90 degree Intravenous insulin administration Crack abuse effect on newborns their own insulin with supervision Teacfh only the essentials on the first few visits and intense later Keep session for children to 14-20 and adult may go up to 45-60 Can only be done with regular insulin in management of DKA, HHNK It crosses the placenta and enter the fetus Infant may appear normal or develop neurological problem child may develop depression or excitability, they may be lethargy, have poor suck ;hypotonia, weak cry and difficulty in arousing, hypotonicity, rigidity, irritabilisty, inability to console and spread with peanut butter through the tubing before starting the drip because the insulin can chemically bind to plastic Replace fluid over 24-48 hrs Premature discontinuation can cause prolongation of DKA Make sure you institute insulin injection before you stop the infusion if not, there might be prolonged hyperglycemia Some infant showed late symptoms 2-8 wks There may be growth retardation, small head decrease birth length, head growth is one of the best indicaton Page 62 of 64 Study Guide for NLN RN Pharmacology Exam High dose Ibuprofhen therapy Non steroidal anti-inflammatory intolerance to change Treat mild to moderate pain absorbe in GI Metabolize in liver Therapeutic effect takes up to one month Oxytocin (Pitocin) Labor and delivery Only this drug is approve by food and administration in this class Administer by one route at a time May be given after a client had experience incomplete abortion to help expel the fetus Onset is immediate Half life 3-5 To improve uterine contraction at term ie only when cetvix is dialted and presentation of fetus has occurred to induce or stimulate labor, reduce postpartum bleeding, incomplete abortion, challenge test to assess fetal distress in high risk pregnancy Use to stimulate the letdown reflex relieve pain from breast engorgement Other reaction affects the CNS, renal system, eyes Nephrotoxicity,; dysuria, hematuria, oleguria, azotemia, blurred vision Adverse/Toxicity subarachnoid bleed, seizure, coma, water intoxication, hypertension, arrhythmias, titanic uterine contractions, abruption placentae, impair uterine blood flow, increase uterine motility, anaphylaxis, anoxia, asphyxia, bradycardia Increase toxicity of dig, anticoagulant, lithium Nurse report blurred vision ringing and roaring in ear which may indicate toxicity REPORT change in urine pattern increase weight, edema, increase pain in joints,, fever, blood in urine indicating Nephrotoxicity Nurse monitor uterine contraction pattern, fetal heart rate, and BP Postpartum; monitor locjia and BP Increase dose only after assessing contraction FHR, maternal BP and HR Do not increase after desired contraction pattern is achieved (contraction frequency of 2-3 lasting 60 sec) Report sudden HA Page 63 of 64 Study Guide for NLN RN Pharmacology Exam Abbreviations: Ac Before meals Bid - Two times daily Qd Every day Tid Three times daily P After IM -Intra muscular IV - Intra venous Qid Every other day Po -By mouth Calculations: IV drip rates half life Drops per minute Milliliters per dose Mg/kg/day Units per hour Milliliters per minute Gm to mg -1000mg = gm Milliliters to liter -1000ml = liter Page 64 of 64 [...]...Study Guide for NLN RN Pharmacology Exam hours Cyanocobalamin (Vitamin B12) stored in the liver most potent vitamin a watersoluble vitamin that is stored in the liver most potent vitamin deficiency result in megaloblastic anemia,... rash severe optic nerve atrophy Do not breast feed while giving this drug sever liver or kidney insufficiency Combined with MOA may precipitate hypertensive crisis Page 11 of 64 Study Guide for NLN RN Pharmacology Exam overdose, toxicity, side effects Cyclosporine (Sandimmune) Immunosuppressant medications Inhibit T helper and T suppressor cells Block production of antibody B cell Inhibit inflammatory... or other irritation, or drainage, discharge, or bleeding from the ear Do not use this medication in a child younger than 12 years old without the advice of a doctor Page 12 of 64 Study Guide for NLN RN Pharmacology Exam have a serious side effect such as: hearing after using the ear drops; mild feeling of fullness in the ear; or mild itching inside the ear ear canal drop the correct number of ear drops... damage your ear drum Remove the syringe and allow the water to drain from your ear into the sink or bowl Do not use carbamide peroxide for longer than 4 days in a row Page 13 of 64 Study Guide for NLN RN Pharmacology Exam Diazepam (Valium) CNS agent, Benzodiazepine (have zep and zap in them), they are minor tranquulizersanticonvuls ant, anxolytic skeletal muscle relaxant Absorbe from GI, metabolize in... irritation Monitor apical Contra: avoid in clients with hypersensitivity to dig, do not give full dose if pt receive dig in previous week, Interaction: IV calcium Page 14 of 64 Study Guide for NLN RN Pharmacology Exam heart rate) Therapeutic range: 0.5-2.0ng/ml Toxic level > 2 Antidote: digibind (digoxin immune fab If calcium is to be given watch for bradycardia since calcium potentiate the action... alcohol must In people who does not want to stop drinking Severe cardiac disease, psychoses, pregnancy, multiple drug dependence Acetaldehyde syndrome the adverse Page 15 of 64 Study Guide for NLN RN Pharmacology Exam of alcohol Use only in people with high physical health Use for 1-2 wks Taken as single dose in the morning Half life 24-36 hour Onset up to 12 hr Duration up to 2 wks Absorbed from the... inhibitors may lead to hypertensive crisis Narrow angel glaucoma, hemorrhagic traumatic or cardiogenic shock, arrhythmias, organic heart or brain disease CAUTION in older Page 16 of 64 Study Guide for NLN RN Pharmacology Exam min & last up to 4 hrs, or inhalation Adrenergic Receptors Beta 1 receptors increase HR and force of myocardial contraction block and restore cardiac rhythm in cardiac arrest Also use... renal impairment, Use cautiously in pt with impaired renal or hepatic function Do not breastfeed avoid antacid( agent reducing acidity) use within 1 hr of dose for Page 17 of 64 Study Guide for NLN RN Pharmacology Exam helicobacter pylori found in gastric mucosa Absorbed in GI Onset 1 hr Peak 1-3hr Duration 10-12 hr Half life 2.5-4hr Metabolize in liver, eliminated in urine Fluoxetine hydrochloride... quantity The combination of TCA and MAOI can lead to hypertensive crisis from excessive adrenergic stimulation of the heart and blood vessels Do not take while pregnant Page 18 of 64 Study Guide for NLN RN Pharmacology Exam rigidity, temp, resp, pulse increase There is change is mental status, tremor, hyperthermia, sweating hypersalivation Notify doctor Fluphenazine (Prolixin) typical; neuroleptic drug and... milk soup To remember side effect remember ABCDE Antichologenic (dry mouth), Blurred vision Constipation, Drousiness, EPS, Photosensativity, Agranulocytosis=decrea Page 19 of 64 Study Guide for NLN RN Pharmacology Exam blunted effect poor judgment, poor self care) Half life > 24 hours Onset 1 hr, peak 0 5 hr meds effect can be seen 1-2 days, substantial improvement takes 2-4 wks Furosemide (Lasix) Loop ...Study Guide for NLN RN Pharmacology Exam Alteplase recombinant (Activase) Thrombolytic Streptokinase, urokinase given mostly... Severe renal disease, dehydration hypercalcemia andhypercalciuria Page of 64 Study Guide for NLN RN Pharmacology Exam Ampicillin (Ampicin) IV, PO, IM Treat bacterial infection Shigella, salmonella,... lead to Increase antichologeneric effect with phenothiazine, Page of 64 Study Guide for NLN RN Pharmacology Exam For ophthalmic use It decreases involuntary movement and rigidity in parkinsonism